ations and policy.In the United States, approximately 12 million individuals seek medical care for pharyngitis each year, accounting for about 2% of ambulatory care visits. Although the gold standard for diagnosing group A streptococcus (GAS) is culture, it is time intensive. Rapid antigen detection tests (RADT) with or without culture confirmation are commonly used instead. Although RADT provide results quickly, they generally have lower test sensitivity. Recently, point-of-care nucleic acid amplification tests (POC NAAT) have emerged. This study evaluates the cost-effectiveness and budget impact to the US payer of adopting POC NAAT.
This study was a cost-effectiveness analysis, with costs and outcomes calculated via a decision tree.
A decision-tree model quantified costs and outcomes associated with a GAS diagnostic strategy using POC NAAT compared with RADT + culture confirmation. Model inputs were derived from the published literature. Model outputs included costs and clinical effects quality-adjusted life-days lost,agnosis and treatment decisions in the United States.Inferior total knee arthroplasty (TKA) outcomes are reported in minority populations. Standardized TKA pathways improve outcomes but have not been studied extensively in minority populations. This study evaluated the impact of TKA pathway standardization at an urban teaching hospital that predominantly treats minority patients.
Retrospective cohort study.
This study compared primary TKA outcomes before and after implementation of a standardized multidisciplinary pathway that emphasized preoperative education and discharge planning, preemptive multimodal pain control, and early rehabilitation. Patients were grouped as "nonpathway" (n?=?144) or "pathway" (n?=?182) based on whether they underwent TKA before or after pathway implementation. Outcomes included length of stay (LOS), patient-controlled analgesia (PCA) use, blood transfusion, postoperative hemoglobin, complications, and discharge disposition. Analysis involved negative binomial and multiple logistic regression models, t tests, and Fisher's exacto home, fewer blood transfusions, and higher postoperative hemoglobin, with no difference in total incidence of complication.To develop and prospectively validate a novel model incorporating claims and community-level socioeconomic data to predict preterm birth at scale among pregnant Medicaid women with no history of preterm birth (PTB).
A longitudinal Texas Medicaid cohort study, with 2-year retrospective model building (October 2015-October 2017) and a 1-year prospective model validation phase (January 2018-December 2018).
Inclusion criteria were females aged 11 to 55 years with at least 1 live singleton birth and no history of PTB. The primary outcome was live singleton birth earlier than 35 weeks. https://www.selleckchem.com/products/hada-hydrochloride.html Covariates were medical/mental/behavioral comorbidities, obstetric history, sociodemographic characteristics, and health services utilization. Of multiple models built, the most parsimonious was selected to classify pregnancies as very high, high, medium, and low risk. Model performance was evaluated using positive predictive value (PPV), sensitivity, case identification ratio (1?/?PPV), and timing of prediction.
The model wad and community data readily accessible by Medicaid plans to support population-level interventions to prevent PTBs.Patient-centered care, defined as "providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions," is advocated by clinicians and professional organizations and is part of a composite criterion for augmented reimbursement for various health care settings, including patient-centered medical homes. Despite general agreement that patient-centered care is a good idea and worthy of incentivization, patient-centered care is difficult to assess accurately, scalably, and feasibly. In this commentary, we suggest that assessment of patient-centered care may be improved by identifying circumstances that indicate its probable absence-in particular, by flagging probable discordance between a patient's preferences and their treatment care plan. One potential marker of this discordance is persistent lack of control of a comorbid condition that is easily controllable by existing therapies and where existing therapies are sufficiently diverse to be compatible with a wide range of patient preferences (eg, stage 1 hypertension, type 2 diabetes with glycated hemoglobin? less then ?8.5%). We outline how this approach may be tested, validated, and harmonized with existing quality improvement activities.To determine whether enough primary care providers are in close proximity to where dual-eligible beneficiaries live to provide the capacity needed for integrated care models.
Secondary data analysis using dual-eligible enrollment data and health care workforce data.
We determined the density of dual-eligible beneficiaries per 1000 population in 2017 for each of 3142 US counties. County-level supply of primary care physicians (PCPs), primary care nurse practitioners, and physician assistants was determined.
One-third of the 791 counties with the highest density of dual-eligible beneficiaries had PCP shortages. Counties with the highest density of dual-eligible beneficiaries and the fewest primary care clinicians of any type were concentrated in Southeastern states. These areas also had some of the highest coronavirus disease 2019 outbreaks within their states.
States in the Southeastern region of the United States with some of the most restrictive scope-of-practice laws have an inadequate supply of primary care providers to serve a high concentration of dual-eligible beneficiaries. The fragmented care of the dually eligible population leads to extremely high costs, prompting policy makers to consider integrated delivery models that emphasize primary care. However, primary care workforce shortages will be an enduring challenge without scope-of-practice reforms.
States in the Southeastern region of the United States with some of the most restrictive scope-of-practice laws have an inadequate supply of primary care providers to serve a high concentration of dual-eligible beneficiaries. The fragmented care of the dually eligible population leads to extremely high costs, prompting policy makers to consider integrated delivery models that emphasize primary care. However, primary care workforce shortages will be an enduring challenge without scope-of-practice reforms.